HUMC Onsite Registration Form
Use this form to take onsite registrations.
Your Station Number
*
Station1
Station2
Station3
Station4
Conference Type
Ministers' Conference
Choir Guild Workshop
Personal Info
Name
First Name
Last Name
Title/Position
Gender
Male
Female
Age Group
18-50
51-64
65+
Hampton U. Alumni?
Yes
No
What Class Year? (If Hampton U. Alumni)
Seminary Student
Contact Info
Address
City
State OLD
State
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Fax
Please enter a valid phone number.
Format: (000) 000-0000.
Church Section & Denomination
Title/Section
Church Denomination
Business Info
Name of Church/Business
Address
City
State
Zip
Campus Rooms Reservations
Air-Conditioned (w/Roommate)
Unit Price: $200
Air-Conditioned (NO Roomate)
Unit Price: $400
$5 Laundry Card
Unit Price: $5
$10 Laundry Card
Unit Price: $10
Check here if you require wheelchair/Handicap Access
Handicap/Wheelchair Access
Roommate's Name
Meal Info
Meal Ticket
Yes
No
Full Plan Meal Ticket
Unit Price: $210
Modified Plan Meal Ticket
Unit Price: $145
Special Needs Requested
Back
Next
Registration Fee Details
Registration Fee
Unit Price: $325
Seminary Student
Unit Price: $250
Music Packet
Unit Price: $80
Continuing Ed. Units
Unit Price: $60
On-Site Registration Fee
Unit Price: $350
On-Site Seminary Student Registration Fee
Unit Price: $275
Seminary Student Adjustment Fee (if registered previously)
Unit Price: $75
Customer's name and title as it should appear on ID badge
Payment Method
Money Order
Cashier's Check
Certified Check
Credit Card
Cash
Subtotal
Conference Fees Subtotal
Lodging/Meals Subtotal
Grand Total
Submit
Should be Empty: